Internet gets fast results for outcomes project

Centers receive weekly reports, on-line training

Talk about quick turnaround: When surgery centers send data to the Surgical Outcomes Monitoring System, they can retrieve comparative reports within a week for 10 outcomes indicators and nine procedures. They can send instant comments to the project director or ask for help with their outcomes management.

The key to this rapid feedback: the Internet.

The American Association of Ambulatory Surgery Centers (AASC) in Chicago is among the first to base its outcomes program on the Internet. Members can download software, receive updates and reports by e-mail, and communicate with colleagues around the country.

"Our goal is to be real-time," says Louis Rossiter, PhD, co-principal investigator for the AAASC Surgical Outcomes Monitoring System. "You collect your data and click, it will recalculate it for you. The technology is available to do it."

The benefits of rapid feedback extend beyond the data and analysis. Participants, who pay no fee but must be members of the association, can "talk" and receive support through the Internet as well.

Rossiter has experience teaching via the Internet; for 10 years, he has taught a course on health economics as part of the executive master's program in health administration. Rossiter is professor of health economics at the Williamson Institute for Health Studies at the Medical College of Virginia of Virginia Commonwealth University in Richmond, which is a partner in the outcomes project.

"What really makes our program unique is the use of the Internet, not only for data collection but for training and communication," Rossiter says. "We have been applying some of the things we learned there [in teaching] to bringing these centers on-line."

Internet offers easy setup

The Internet also brings a certain technological ease to outcomes management. Participants need only a Pentium personal computer with the Windows 95 operating system, a 28.8 kbps telephone modem, an Internet service, and the FileMaker Pro Version 3 or 4 database management software. Participants can download additional software from the project's World Wide Web page, which gives step-by-step directions.

"It really is as easy as going to [a computer store], getting off-the-shelf hardware and software, and plugging it in," says Rossiter. "We have considered other, more complex Internet software and rejected it because the beauty of this program is the accessibility for everybody."

When comparative reports are ready, participants receive an e-mail notice. Surgery center staff also can enter the information on-line. They fill out a medical abstract form to collect clinical information from the medical record, and nurses use a patient telephone interview form to ask a set of questions during the standard follow-up phone call after discharge. (See a copy of the form, inserted in this issue.)

While Rossiter recommends the on-line method, at some centers, nurses conduct the interviews then give the forms to clerks to input the data. Either method is not difficult or time-consuming, says Stephen E. Zimberg, MD, MSHA, an obstetrician/gynecologist who is secretary of AAASC and vice president of the Lakeview Medical Center in Suffolk, VA, one of the first centers to join the outcomes project.

"It takes about seven minutes to do the survey," says Zimberg. "That's the time you're spending when you call the patient anyway."

The center's own cumulative data are available immediately. "When you're finished [with the survey], you can [determine] the percentage that are most satisfied, the percentage that had pain, and you can analyze all that data," says Rossiter.

The same-day surgery project is designed for flexibility as centers conduct their own quality improvement efforts. They can add several parameters that are unique to the center. For example, the project doesn't provide comparative data by physician, but centers can use physician identifiers to pinpoint variation among their surgeons.

"This was designed for the sites, not for the individual physician," says Zimberg. "We want the sites to be able to say 'I've got great patient quality, and I can prove it.'"

That demonstration of quality becomes more important as the Joint Commission on Accreditation of Health Care Organizations in Oakbrook Terrace, IL, and the Accreditation Association for Ambulatory Health Care in Skokie, IL, prepare to add requirements for performance assessment that would apply to ambulatory surgery centers. (For more information, see related article, below.) The same-day surgery project began with just two procedures, but now centers may send data on the following procedures: breast biopsy, bronchoscopy, carpal tunnel, cataract removal, cystoscopy, gastrointestinal endoscopy, hernia repair, laparoscopy, and knee arthroscopy. Or they may submit data on all procedures at their facility and receive reports that are not procedure-specific.

The 10 indicators include perioperative complications, longer than expected recovery time, and effectiveness of pain relief. As the AAASC project evolves, it will include an auditing function to ensure the integrity of the reported data, he says.

For example, the project may verify that centers are reporting data on all cases within the procedure codes they have chosen for participation, he says. The project also will refine its case-mix adjustment to account for differences among patients. Currently, the database is adjusted for age, comorbidity, and time in surgery.

Eventually, the project could become a network for clinical trials for drugs and devices, Rossiter says. "That would mean that if a pharmaceutical company wanted to try a new drug, each of these sites would be signed up as clinical investigators," he says. "The physicians would agree to use the drug and report the results back to our system. Each ASC would receive compensation for its participation."

But the primary motivation will continue to be quality improvement, he says. "This provides an opportunity for the industry to show the value of ambulatory surgery," he says.

[Editor's note: For more information on the Surgical Outcomes Project of the American Association of Ambulatory Surgery Centers, contact Kari Dabrowski, AAASC, 401 North Michigan Ave., Chicago, IL 60611-4267. Telephone: (800) 237-3768. Fax: (312) 321-6869. E-mail: World Wide Web:]